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�;ONITORING WELL INSTALLATION REP <br /> Date: 611 7 I � �' CONSTRUCTION <br /> Premise Address: Total Depth <br /> /Vl CEJ `„IW Ga G Screen Length (from) (to) 3 <br /> Well No.: Filter Pack (from) _ 3 (to) O <br /> Bentonite (from) (to) <br /> Inspector: _ (� -0 1 _ Grout (from) (to) <br /> Drilling rig <br /> ty <br /> Permit No. q71- log I Auger O.D. 1.D. � <br /> Completion - Stove pipe/cluistie box-(circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant L-V0 T <br /> v r <br /> Geologist <br /> ABOVE-GRCU[VD CNAIS 43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line j 9(eut <br /> Domestic well on site g- y'�n) tgIf es loc on and die- <br /> Y W. � ''i 3041 �� ft- _ ft. <br /> 0 <br /> 0 <br /> SAMPLING iloroi c <br /> �� soc9cn . _ <br /> 3 <br /> Holding Te perature :`: __Method AR.. � PackY;� - <br /> Screening Method — <br /> Tracking Sheet - n ) <br /> .a. <br /> fr- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ nn/'// -// <br /> Storage Location Casing type YU� <br /> Blank SF— ft. Screen' <br /> Slot size 1- <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel / O <br /> Mix Ratios Filter Pack type/ ' e tT <br /> Installation Method C2 r Surge Block: - (Y ll ) <br /> Quantity Installed Discussed wit ologist: (y�( n ) <br /> Type of method <br /> EH 29 29 <br />